Your ADHD assessment
This is a resource rather than a file note. The first part is what we found and what each finding points to. The second is how those findings turn into something you can do. The third is what happens next. The fourth is for a clinician, and you never have to read it.
Your results, and what each one points to
Every finding below is followed by what it means for you in practice, and each suggestion sits with the result it came from.
ADHD, combined presentation
There are two symptom groups in the diagnosis. One is about attention and organisation, and you met six of the nine. The other is about restlessness and acting without thinking, and you met seven of the nine. Both are above the threshold, which is why the diagnosis carries the word combined, and the second group is the higher of the two.
You came in describing a pattern rather than a symptom: all in on a new idea for a few weeks, then the drive falling away at the point the work stops being built and starts being maintained. That pattern is what the two highest scores in this report describe.
ADHD is a difference in how self-regulation works, not a difference in effort or in how much you care. That is why the advice you have been given for forty years, which amounts to trying harder, has not changed anything. The capacity it asks you to use is the one that works differently.
So: when you explain this to your team or to Alex, describe it as where your drive comes from rather than how much of it you have. People hear "ADHD" and picture a child who cannot sit still, and you will spend the conversation correcting them.
The five things that had to be true
A diagnosis is not one finding. It is five separate questions, each answered from a different source.
The second line is the one resting on a single source. Everything else here is supported from more than one direction.
So: if a school report or an old exercise book ever turns up, it is worth adding to your file.
What was already happening
ADHD is present from childhood, so the pattern has to be there before the age of twelve. Yours is described rather than documented, and we have said so rather than implied otherwise.
Early primary
Out of your seat, talking over people, losing jumpers and lunchboxes constantly. Described at home as never still.
Your recollection, interviewLate primary
Reports saying bright but not applying himself. Work started and not finished. Reading tasks avoided, anything practical or physical done well.
Your recollection, interviewSecondary
Left as soon as you could and went into a trade, where the work was hands-on and the day had a visible finish. You described school as something you got through rather than did.
Your recollection, interviewFamily history
Your father was described in the same terms you were, and was never assessed. A nephew has since been diagnosed.
Developmental and life history formThe childhood questionnaire
Your score was 58 against a cut-off of 46. The fuller scoring, built to tell an ADHD childhood from an anxious or low-mood one, came out at plus 5.5 and plus 6.8, both on the ADHD side.
WURS-45, completed by youChoosing a trade at sixteen was the first system you built. Hands-on work with a visible finish supplies structure that classroom work does not, and you found it without anyone explaining why it suited you.
So: the same test applies to any decision about the business. Work that comes with its own structure costs you less to do than work where you have to supply all of it.
Where it shows up day to day
Projects and delivery
Strong start, then the drive falls away at the point a project needs maintaining rather than building. Several ideas started in the last two years, few carried through by you.
Financial decisions
Commitments made at speed under the pull of a new idea, and reviewed later with a different view of them. Your business partner sees this one.
Running a team
New direction set at a pace others cannot match, so people are on board and still three steps behind.
Admin and obligations
Appointments, quotes and orders live on paper and in alarms rather than in your head. Held by the system rather than by memory.
Home
Follow-through at home falls unevenly, and Alex carries more of it than either of you planned.
Evenings with your kids
A shorter fuse and less patience on days you have not trained. You raised this yourself as the thing you least want to keep happening.
Look at what is holding each of these rather than at the list itself. Four are held by systems you built, two are held by Alex, and none is held by nothing going wrong. That is why it can look manageable from the outside and still meet the threshold for a diagnosis.
So: the cost is real, it is just being absorbed rather than showing up, mostly by you and partly by Alex. Section two is about moving that cost onto something that is neither of you.
Five areas of day to day self-management, and what each one suggests
These five come from a questionnaire that compares your answers with other adults your age. The scores themselves are in section four. What matters here is what each one is doing to your week, and what could take that load off you.
The gap between deciding and acting
Clearly significantA short gap between a decision forming and acting on it is one of the most consistent findings in ADHD, and this is your highest result. The decision arrives before the slower weighing-up part has caught up, which is what sits behind the business calls that felt right on the day and looked different a month later.
A dollar figure, set with your business partner, above which nothing is committed to on the day it comes up. Above that line, one button on your phone logs the decision, timestamps it, and books a reminder to revisit it in 24 to 48 hours.
Why this follows: the waiting is the thing that helps, and asking yourself to hold off is asking the exact capacity this result describes. A timer does the waiting whether or not you feel like waiting.
Holding effort once the novelty has worn off
Clearly significantIn ADHD, drive depends heavily on whether something outside is supplying a deadline, a measure or a person waiting. This measures holding effort when none of those is present, and it is your other highest result. It is not about how much you care. Caring was never the part that was missing.
A written handoff point inside the project template, so the prompt to hand over arrives with the work rather than depending on you noticing the stage. For anything that has to stay with you, a date and a visible measure attached to it from the start.
Why this follows: you have held a triathlon schedule for years through winters, injuries and busy seasons. That schedule supplies a date, a measure and people who notice. Those are the conditions this capacity runs under, so they get built into the work rather than hoped for.
Breaking something large into an ordered sequence
Some difficultyGenerating the order that a job has to happen in is a common difficulty in ADHD, and it is separate from having the idea. The idea arrives whole. The sequence does not. This is the area behind a new direction landing with your team faster than they can act on it.
Sequencing done out loud with one other person before anything is announced, and written down during that conversation rather than afterwards.
Why this follows: the sequence has to exist somewhere before it can be followed. Doing it out loud puts it outside your head at the moment it is generated, which is the only moment it is easy to capture.
How quickly frustration settles again
Some difficultyEmotional regulation in ADHD is usually a question of speed rather than size. The reaction arrives before the weighing-up does, and it takes longer to come down again. Yours came out moderate, and where it costs you is the evening, which is the end of a day of decisions and the point at which there is least left in reserve. The shorter fuse with your kids is that, not a separate problem.
You have already built the transition this needs. The end of day routine happens at the yard rather than at home so that you walk in the door without the day still running. On days it gets skipped, nothing fills that gap. Give it a short version that still happens when you are flat out, even if it is five minutes in the ute before you get out.
Why this follows: once a reaction has started it is hard to catch, which is what this result measures. The place that can be changed is what you are still carrying when you walk in, and that is upstream of the reaction rather than in it.
Judging time and keeping track of commitments
Typical rangeThis is the area most adults with ADHD find hardest, and yours sits in the typical range. The reason is not that you remember better than other people. It is that you stopped asking yourself to. Before you leave the yard you write tomorrow down, flag the quotes, list what needs ordering and set the alarms, so the commitments live on paper and in alarms rather than in your head.
An automation that fires at a set time each afternoon and opens the list for you, so the routine starts itself on the days you are flat out.
Why this follows: this result is the clearest evidence in the report that systems work for you. The only weakness in it is that the whole thing currently depends on you remembering to start it, and the day you are too busy to write anything down is the day it would have earned its keep.
How much you are compensating, and whether it is working
One of the questionnaires asks two things the others cannot see. How much you rely on workarounds, and how well those workarounds are holding. Read together, they show how much effort the week is costing and how much of that effort is coming back.
Your use of strategies came out high. The end of day routine, the written lists, the habit of trusting paper rather than memory. Day to day, those systems are holding. Across months rather than days, they thin out.
A system that holds is not evidence the difficulty was mild. What it measures is whether the workarounds are absorbing the demand, not how much demand there is. Nothing about your week looks hard from the outside, and that appearance is the work you have been putting in.
So: a system that needs you to keep deciding to run it is running on the capacity this report says is hardest for you to supply. That is the single change worth making, and it applies to systems you have already built rather than to new ones.
Four strengths, each tied to something in the assessment
01 · You built your own external memory system without being taught one
Evidence: your time management result, read against your two highest scores. Writing the next day down before you leave the yard is the reason time management sits in the typical range while the areas either side of it do not. Nobody prescribed that routine. You worked out that the load had to sit somewhere other than working memory, and you built the place for it to go.
You do not need to be taught how to build a system. You need the ones you build to stop depending on you to start them.
02 · Your persistence runs when the conditions supply it
Evidence: the self-motivation result, read against a triathlon schedule held for years. Those two facts sit together rather than contradicting each other. The capacity for sustained effort is there. It runs when there is a fixed date, a visible measure of progress, and someone who will notice, and it does not run when those are absent.
This is a condition to build rather than a trait to acquire. Where a piece of business work has to stay with you, putting those same three conditions around it on purpose is setting the task up the way you already know works.
03 · You found a regulation strategy before anyone named it
Evidence: the emotion regulation result read against the impulse control result, and Alex's separate account. Emotion regulation came out moderate while impulse control, which sits right beside it, came out much higher. You and Alex described the same difference between a training day and a day without one, without comparing notes.
A 2025 systematic review and meta-analysis of adults with ADHD found that both a single session of exercise and a sustained training program were associated with better performance on tests of inhibitory control, with the sustained effect the larger of the two (Yang et al., 2025). That review covered eight articles and 373 participants, so the sustained estimate is imprecise. It is a group-level finding, and what training does for you on any given day is your own observation rather than something this assessment measured.
Training is currently the only tool of its kind you own, and the weeks it disappears are usually the heavy ones. A backup decided in advance matters more than protecting the schedule.
04 · Your systems sit at the point of use, which is why they hold
Evidence: the compensation measure. Use is high and day to day effectiveness is high. Every workaround you built sits at the moment it is needed rather than in a plan made earlier. The list gets written before you leave the yard, not on a Sunday night. The alarm gets set when the job is booked, not when you next review the diary. That is why the measure shows them holding rather than slipping, and it is the part most people get wrong when they try to build the same thing.
The one place the same measure shows them thinning is across months rather than days, which is the drive result appearing from a different angle. Your systems do not need redesigning. They need to stop depending on you to restart them.
So: when you add anything in section two, put it at the moment it is needed, the way you already do. A system that asks you to remember it later is asking the capacity this report says is hardest.
How those findings turn into something you can do
Section one put a suggestion beside each result. This section sets out why those suggestions take the form they do, and how to run them as systems rather than as intentions.
We look at systems before we look at effort
Working memory, time blindness and the gap between deciding and acting are the parts of ADHD that respond least to effort, and effort is what has been carrying them for forty years. They respond to being handled outside your head, by something that runs whether or not you remember to run it. When a system holds the demand, your brain is not being asked to do the thing it is least inclined to do, and the capacity that was going into holding it is free for something else.
You already have proof of this in your own results. The end of day routine at the yard has a name. It is called cognitive offloading, and it means putting a demand somewhere outside your head so the remembering is done by the world instead of by you. You built it for one problem, without anyone naming it, and it is the reason one of your five results sits in the typical range.
It works. A 2026 meta-analysis found that using an external aid improves performance on memory-based tasks, and separately that it narrows the spread between people, more so for remembering to do something later than for recalling something past (Burnett & Richmond, 2026). That is the part your results put in the hardest range.
The Australian ADHD guideline calls this environmental modification, meaning the surroundings change rather than the willpower, and lists it among the components that belong in cognitive behavioural work with adults (AADPA, 2022, clinical practice point 4.2.13). The rest of this section is the same move you already made, pointed at the areas it has not reached yet.
Four moves that turn a suggestion into a system
Every recommendation in section one is one of these four, pointed at a particular result.
Put it down the moment it arrives
The quote mentioned to you while your hands are full, the thing a client says at the gate, the order you will need on Thursday. Working memory holds only a few items at once, and anything still sitting there is using capacity you need for something else. Not at the end of the job, not when you get back to the ute. One place, always the same place, and a voice note counts.
Attach it to a moment, not to a day
"When I get back in the ute, I send the quote" beats "I will do quotes this week". Plans tied to a trigger outperform plans tied to a time, across 642 tests. The average advantage was small to begin with, and under one method of correcting for publication bias it falls further, so treat it as a small real gain rather than a fix. It also only shows up when you actually want the thing done (Sheeran, Listrom, & Gollwitzer, 2025).
Hang it off something that already happens
A system that needs you to remember to use it will fail on the days you needed it most. A tag inside the ute door works because opening the door already happens. Find the thing that already happens, and put the new step on it.
Build one, and live with it for a month
A system can turn into its own job. Set one up, use it for a month, and add the next only once the first has stopped needing your attention. If keeping it running starts costing more than the problem it solved, strip it back rather than push on.
Letting the technology carry it
Everything in section one asks something of you: remember the rule, keep the habit, notice the moment. That is the demand your results say is hardest to meet, so it is worth asking which parts do not have to sit with you at all. Your phone can already do most of this, and most people never set it up.
| What currently sits in your head | What could carry it instead | Aimed at |
|---|---|---|
| Remembering to do the end of day routine on the days you are flat out | An automation that fires at a set time each afternoon and opens the list for you, so the routine starts itself rather than waiting for you to remember it | Protecting the one system already holding the most |
| What to take, check or lock before you leave a site | A tag stuck inside the ute door. Tap your phone on it and the checklist opens, with no app to find and no sequence to recall | Working memory at the moment it is needed |
| Holding the 24 to 48 hour pause before a big commitment | One button that logs the decision, timestamps it, and books the reminder to revisit it | The gap between deciding and acting, your highest result |
| Remembering to hand a project over at the agreed point | The handoff written into the project template itself, so the prompt arrives with the work rather than depending on you noticing the stage | Holding effort once the novelty has worn off |
| Getting the day out of your head before you walk in the door | A short version of the end of day routine that still fires on the days you are flat out, so the transition happens even when the full routine does not | How quickly frustration settles again |
| Quotes and orders mentioned to you while your hands are full | Voice capture straight to a list, so nothing depends on holding it until you get back to the ute | Organisation and follow-through |
If you only do two things
Build the handoff into the project template
You generate ideas easily and the drive runs out partway through delivering them. Deciding to care more about the delivery is not the answer, because caring was never the missing part. A written handoff point is a defined moment where the project stops being yours and becomes a named person's. You stay available for input and you stop being responsible for execution.
It does work for two results at once. It removes the demand that your drive has to survive the maintenance phase, and it gives the team a sequence and an owner instead of a direction.
Put a timer on decisions above a figure you set
Set a dollar threshold you are comfortable with, financial or team-related, and make anything above it wait 24 to 48 hours. Log the decision, set the reminder, and revisit it when the timer says so.
Make the delay itself the brake rather than a person. If you want a second opinion in there, your business partner or your accountant is the right place for it. Alex already carries a share of the follow-through at home, and adding sign-off on company spending would make that heavier rather than lighter.
Two things we are not going to do
An app that claims to treat ADHD is a different thing from a checklist that opens when you tap a tag. A 2025 review of 26 systematic reviews found the evidence for digital interventions aimed at improving ADHD symptoms weak and inconsistent, with psychoeducation the clearest exception, and found adverse effects poorly reported (Gabarron, Denecke, & Lopez-Campos, 2025). Nothing above is a treatment. These are tools that hold a demand for you.
The exercise finding is real and it is group-level. It says adults with ADHD performed better on tests of inhibitory control after exercise and after sustained training (Yang et al., 2025). It does not say training treats ADHD, and it does not predict what any given week will be like for you. Your own observation, and Alex's, is the better guide to that.
Every study named above describes what happened, on average, to a group of people who are not you. That is a reasonable basis for choosing where to start and a poor basis for predicting how it will go. If something here does not fit, that is information about the tool rather than about you.
What happens now, and what it costs
Five things are available and none of them is expected. Doing nothing for a while is a legitimate choice and a common one.
Your options
| What you could do | What it involves | Cost |
|---|---|---|
| Sit with it | Read the report again in a month. A lot of people need the answer to settle before they do anything with it. | Nothing |
| Use what is already in here | The handoff point, the timer on big decisions, the protected end of day routine, and the technology table in section two. All of it is written down so you can work through it alone. | Nothing |
| Work with a psychologist | Building and testing the systems against your actual week rather than in principle, working out what to hand over, and how to have that conversation with your team. | $240, or $260 after 5pm and Saturdays. With a Mental Health Treatment Plan the rebate is $101.55, so $138.45 out of pocket, or $158.45 after hours. |
| Work with an ADHD coach | Practical rather than therapeutic. Systems, follow-through, and someone expecting an answer from you on Friday, which is the condition your drive runs under. | Privately funded. No Medicare rebate applies. |
| Explore medication | Your GP extends a referral to a psychiatrist, who does their own assessment. The clinical report from this assessment goes with them, and your GP arranges the tests listed below beforehand. | See below. Prescribing and any dose adjustment sit with the psychiatrist. |
If you go down the medication path, there are two routes
The fees below are Dr Luisa Fernandez's, and they apply only if you choose to work with her. She is the psychiatrist we refer to, not the only one you can see, and another psychiatrist will have their own fees. The two routes differ in who holds the prescribing once the dose is settled.
Your GP prescribes
She assesses you once, writes a plan, and hands care back to your GP, who prescribes from then on. There is no routine review with her afterwards.
This only works if your GP is willing to take the prescribing on, so we ask them to confirm that before anything is booked.
The psychiatrist prescribes
She takes you on as her patient and manages the medication and the dose herself, with a review at about a month and then roughly every six months.
Your GP is not asked to prescribe, which makes this the route when they would rather not.
These are Dr Fernandez's fees, set by her rooms and not by Equal Psychology, and correct at September 2026. Benefits shown are the 85 per cent benefit for these items as they stand from 1 July 2026 and are indexed each year. Either route is a separate appointment with a separate fee, booked directly with her practice. Equal Psychology receives no payment or benefit for referring.
Medication works on the symptoms. It does not build the handoff, decide what you delegate, have the conversation with your business partner, or set up the system that catches the things you drop. That part is work, and it is the part we do.
Plenty of people manage that alone, and plenty of people take medication and never see a psychologist again. We are not suggesting you need us.
Worth raising with your GP
Nothing in your physical screen was positive, so this is a list of conversations rather than a list of problems. A screening question is not a diagnosis, and we are not able to advise on physical health.
| What to raise | Why it is on the list |
|---|---|
| That the assessment has happened | A number of physical health conditions occur more often in adults with ADHD than in adults without it, and adult ADHD has been associated with a modestly increased cardiovascular risk (Li et al., 2023). What that means for you is a question for your GP rather than for us. |
| Fatigue, sleep and concentration | These can come from physical causes as well as from ADHD. We asked screening questions. Your GP knows the rest of your health history and is the right person to decide whether anything warrants a closer look. |
| How much you train | Endurance training at your volume is relevant background for a GP thinking about your general health, and it is the sort of thing that gets left out of a ten-minute appointment. |
| Tests before a psychiatry appointment | Full blood examination, thyroid function, liver function, iron studies, vitamin B12, HbA1c, a lipid profile, an ECG, and a baseline blood pressure and heart rate. Your GP arranges these, and having them in the room means the first appointment can be about you rather than about waiting. |
If you see a psychiatrist, raise these three
The full substance history
Including the period in your twenties. A psychiatrist considering a stimulant needs it, and it is better given by you than found later. Take the detail with you: what, when, how often, and when it stopped.
Your training volume
Endurance training, appetite, sleep and heart rate sit in the same conversation as stimulant medication, and the psychiatrist will want to know beforehand rather than afterwards.
Plant and machinery
You operate equipment and drive for work. How any medication affects alertness, particularly while a dose is being adjusted, is a conversation to have before you start. Nothing in this assessment says anything about your competence to do your job.
Other places to get support
Other adults who have it
Because most of what works here is practical, and other people have already built it. ADHD Australia keeps a directory of support groups at adhdaustralia.org.au. ADHD Foundation Australia runs online groups at adhdfoundation.org.au. Neither assesses or treats anyone. Free, and nobody needs a referral.
Sleep and training, treated as part of the picture
Because the difference Alex described between a training day and a day without one puts the training somewhere other than fitness. The guideline asks clinicians to ask about sleep, diet and physical activity and to offer strategies or a referral where one is needed, as part of adult ADHD care rather than as an afterthought (AADPA, 2022, clinical practice point 4.1.1). Your sleep screen was negative, and your training load makes protecting sleep worth doing regardless.
What this assessment does not settle
The childhood picture. It rests on your own recollection, supported by the questionnaire but not by a school report, a parent or a sibling. It is the part of this assessment resting on a single source.
Anything an objective test would tell us. Every standardised measure here is self-report, so they record how you experience your own functioning rather than measure it from outside.
Learning ability. No cognitive or academic testing was done, so this says nothing about learning difficulties or ability.
Anything about your physical health. We asked. We did not test.
None of that changes the conclusion. It marks out where the conclusion is firm and where it rests on a single strand.
Who reads this is your decision
This report belongs to you. We do not send it anywhere without your say-so. Most people give it to their GP. A psychiatrist does not need it, because they get the clinical version written for them. Beyond that it is entirely up to you.
One thing to think about before you hand it further. Employers, insurers and licensing bodies sometimes ask health questions, and what you are obliged to tell them varies by the policy and the situation. We are not able to advise you on that and would be out of our depth if we tried. If you are ever asked, get your own advice first, and talk to us before you send anything. We can prepare a version with any section left out, and we can write something shorter for a specific purpose.
If any part of this report is wrong, or lands differently than it did in the room, tell us and we will change it. It is your record.
You have spent years building systems that hold, without anyone telling you they were doing real work. That is a starting point, not a deficit to fix.
For a clinician
The method, the scores with their reference points, the evidence table and the alternatives worked through. This part is written for a GP or another psychologist reading over your shoulder. It is here because it is yours, not because you need to read it.
The scores behind section one
Five areas of day to day self-management, compared with other adults the same age. The bar runs from the 0th percentile on the left to the 100th on the right. The 85th and 93rd percentiles mark the band boundaries, and the 93rd is the threshold for clinically significant.
The gap between a decision forming and acting on it. The highest result in the profile.
Holding effort after the novelty has gone and before there is any payoff.
Breaking something large into an ordered sequence of steps.
How quickly frustration settles again. Moderate rather than severe, and lower than the restraint result beside it.
Not what the profile either side of it would predict. Attributable to the self-built end of day offloading routine rather than to an absence of difficulty in this area.
Compensatory strategies
These scales have no comparison group. The positions describe the answers. They are not percentiles, and they should be read together rather than separately.
High present-oriented effectiveness is not read here as reassurance. In the validation study the present-oriented scale was related to symptoms, executive dysfunction and impairment while the future-oriented scale was not, and the direction of that relationship is not settled, so neither scale is read on its own as an index of how well the client is managing (Castagna, Roye, & Calamia, 2019). The future-oriented result is held more lightly for that reason, and is consistent with the self-motivation finding.
Every source, and what each one showed
| Source | What it showed | What that speaks to |
|---|---|---|
| ASRS v1.1 | Five of six Part A screening items at or above threshold. Both clusters endorsed in Part B, hyperactive-impulsive more strongly. | The pattern now, and its shape |
| WURS-45 | Embedded 25-item score of 58 against a clinical cut-off of 46. Fitted value plus 5.5 against depression or anxiety and plus 6.8 against non-clinical, both on the ADHD side. | Childhood onset, and which kind |
| Developmental and life history | Inattention, restlessness and lost belongings from early primary school. Family history on the paternal side. | Childhood onset, self-reported |
| BDEFS | Two of five areas clinically significant, two in the some-difficulty range, one typical and accounted for by compensation. | Impact on functioning |
| CABS | High use of workarounds, holding day to day, thinning across a longer horizon. | Impact, and effort that hides it |
| Collateral from Alex | The same pattern described from outside, in the business and at home. Given in session with the client present, so supporting rather than independent. | More than one setting |
| Clinical interview | A consistent account across two sessions, with the alternatives tested directly. | All five criteria |
| Co-occurring and physical screens | Nothing reaching a level that better explains the pattern. | No better explanation |
What was used, and what each part cannot tell us
| Instrument | Completed by | What it can tell us | What it cannot |
|---|---|---|---|
| ASRS v1.1 | Client | How often the core patterns show up now (Kessler et al., 2005) | Nothing about childhood, and it misses roughly three adults in ten who do have ADHD. |
| WURS-45 | Client | How much of the pattern was there in childhood, and whether that childhood looks more like ADHD or more like anxiety and low mood (Ward et al., 1993; Reimherr et al., 2022) | It relies on memory of decades ago and is not a record of what happened. |
| BDEFS | Client | Five areas of day to day self-management, compared with other adults the same age (Barkley, 2011) | Why those areas are difficult. It measures the difficulty, not the cause. |
| CABS | Client | How much he relies on workarounds, and whether they hold (Castagna et al., 2019) | It has no scores to compare against and is descriptive only. |
| Collateral history | Alex, in session one with the client present | How the pattern looks to someone else in his adult life | Alex did not know him as a child, and the account was not given independently. |
| Clinical interview | Matthew, across two sessions | The alternatives, the impact, and whether each criterion is actually met | It works from what is disclosed and what is remembered. |
Why the 45-item WURS was used rather than the 25-item version
The 25-item score detects childhood difficulty but discriminates poorly between ADHD and depression. In the validation sample the clinical cut-off of 46 correctly classified 86 per cent of adults with ADHD and 99 per cent of controls, but also classified 81 per cent of depressed adults correctly, meaning roughly one in five depressed adults scored above it (Ward, Wender, & Reimherr, 1993).
The 45-item version groups into five factors, weighted and combined into fitted values built specifically to make that discrimination (Reimherr et al., 2022). Factor scores here were disruptive 2.4, ADHD 3.1, academic 2.3, social 1.2, anxiety and dysthymia 1.1, with negative-loading items subtracted per the handbook scoring sheet. Both fitted values were positive.
The scale remains retrospective self-report and is subject to recall bias. Current mood state is a recognised influence on how adults rate their own childhood, a highly structured childhood can suppress the score, and several items overlap with the effects of childhood adversity rather than ADHD specifically. No childhood informant or school records were available.
What else was considered
The alternatives were worked through before the diagnosis was made. None of them accounts for the pattern better.
Mood, anxiety and stress · considered, not the explanation
DASS-21 responses sat in the normal range across all three subscales. The attentional pattern is lifelong and steady rather than dating from any particular period, and it shows up across stretches of life that looked very different from one another. The childhood measure points the same way, since its fitted values are built to separate an ADHD childhood from an anxious or depressed one and both came out on the ADHD side.
Autistic traits · screened, not indicated
RAADS-14 Screen score of 6, where 14 is the point at which we look further. That screen is deliberately over-inclusive and the published median for adults with ADHD is 15, already above the cut-off, so a score of 6 is meaningful. Nothing in the history pointed that way either.
Trauma and early life · considered
The trauma screen begins by asking whether anything of that kind has happened and only continues if the answer is yes. His did not continue, and nothing in the history or in session one suggested this was driving the pattern.
Sleep · screened, negative
Nothing pointed to insomnia, to daytime sleepiness interfering with his days, to snoring or breathing pauses, or to restless legs. Bed and wake times were asked directly alongside the screen. His training load makes protecting sleep worthwhile regardless.
Alcohol and other substances · considered, not a confound
Asked as part of the history rather than through a scored questionnaire, because substance use can shape the picture. He does not drink and current use is not an issue. A period of recreational drug use in his twenties is recorded as history and has not been treated as evidence for or against the diagnosis, because how a drug felt is shaped by dose, setting and expectation rather than by whether someone has ADHD. It is recorded because a psychiatrist considering a stimulant needs a full substance history.
Physical contributors · screened, negative, routed to the GP
Thyroid problems, low iron and other physical causes can produce fatigue and poor concentration that look like ADHD, and the Australian guideline treats screening for them as part of a thorough assessment (AADPA, 2022). The history form asked about hearing, vision, thyroid, iron and head injury, and the health form asked the five-part hypermobility questionnaire and four questions about symptoms on standing (Hakim & Grahame, 2003; Glans et al., 2020). Responses were negative across this set, with a 5PQ total of 0 of 5 and no orthostatic symptom endorsed above the lowest level. The items listed under the GP section are precautionary and guideline-based rather than conclusions drawn from this screen.
"Is this just what running a business is like?" · considered, does not account for it
He asked this directly. The reason it does not hold is timing. The pattern shows up in how he describes primary school, decades before there was a business, a team or a deadline. The work did not create the pattern. It gave an existing one a bigger stage.
The effort of holding it together. High strategy use with day to day effectiveness is compensation doing its job, and it is usually the source of tiredness that is otherwise hard to account for.
Training. Exercise has been associated with better inhibitory control in adults with ADHD at a group level (Yang et al., 2025), and both the client and his partner describe a day to day difference. It is recorded as context rather than as a finding of this assessment.
Diagnostic criteria
| Criterion | Finding |
|---|---|
| A1, inattention | 6 of 9 symptoms endorsed at a clinically significant level across self-report, interview and collateral. |
| A2, hyperactivity and impulsivity | 7 of 9 symptoms endorsed at a clinically significant level across self-report, interview and collateral. |
| B, onset before age 12 | Met on retrospective self-report. WURS-45 embedded 25-item score 58, above the clinical cut-off of 46; fitted values plus 5.5 and plus 6.8. Evidence strength: no childhood informant and no school records were available, so this criterion rests on recollection. The fitted values address the depressive-misclassification limitation of the 25-item cut-off but do not substitute for a documentary or informant source. |
| C, two or more settings | Met. Work and home, corroborated by collateral from a partner who sees both. Collateral was given in session with the client present. |
| D, functional impairment | Met on directly reported impairment: project completion, rapid financial commitment, the pace set for the team, and the distribution of follow-through at home. Compensatory effort is described separately and has not been counted toward this criterion. |
| E, not better explained | Met. See the alternatives above. |
| Severity | Moderate. Symptoms exceed the number required in both domains. Impairment is present and consistent across occupational and relational settings, the client remains in employment, the relationship is intact, and no domain has broken down. Day to day functioning is sustained by effortful self-built compensation rather than by an absence of difficulty, which is the basis for placing this above mild. |
| Diagnosis | ADHD, combined presentation, moderate severity. DSM-5-TR code F90.2. |
No risk screening instrument sits in the pre-work. That is a deliberate design decision. A screening instrument completed by someone who has not yet met the assessing psychologist creates a duty of care without a therapeutic relationship or a means of responding, and the forms are not monitored in real time. A standing notice to that effect appears on every form. Risk was assessed directly, in conversation, in session one, and documented there.
Limits of this assessment
Collateral was given by a partner during session one with the client present rather than independently, and that partner has known the client in adulthood only. All standardised measures used here are self-report, so they capture how the client experiences his own functioning rather than an objective measure of it. The account of childhood rests on his own recollection, without school records or other documents to corroborate it, and that is the single-source element of this assessment. No cognitive, academic or performance-based testing was undertaken, so this says nothing about learning difficulties or ability. Physical contributors were screened by questionnaire rather than tested, and confirmation or exclusion of those sits with the treating general practitioner. Every screening instrument used here trades specificity for sensitivity by design, so a positive result indicates a question worth asking rather than a condition present. Each diagnostic criterion was established in clinical interview, with the questionnaire results used to direct that interview rather than to satisfy the criterion.
References
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
- Australasian ADHD Professionals Association. (2022). Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). https://adhdguideline.aadpa.com.au
- Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65–94. https://doi.org/10.1037/0033-2909.121.1.65
- Barkley, R. A. (2011). Barkley Deficits in Executive Functioning Scale (BDEFS for adults). Guilford Press.
- Burnett, L. K., & Richmond, L. L. (2026). Meta-analytic investigations of the effect of cognitive offloading on memory-based task performance and interindividual variability. Memory & Cognition, 54(1), 144–168. https://doi.org/10.3758/s13421-025-01743-8
- Castagna, P. J., Roye, S., & Calamia, M. (2019). The Compensatory ADHD Behaviors Scale (CABS): Development and initial validation. Assessment, 26(5), 783–798. https://doi.org/10.1177/1073191118774841
- Gabarron, E., Denecke, K., & Lopez-Campos, G. (2025). Evaluating the evidence: A systematic review of reviews of the effectiveness and safety of digital interventions for ADHD. BMC Psychiatry, 25(1), 414. https://doi.org/10.1186/s12888-025-06825-0
- Glans, M., Humble, M. B., Elwin, M., & Bejerot, S. (2020). Self-rated joint hypermobility: The five-part questionnaire evaluated in a Swedish non-clinical adult population. BMC Musculoskeletal Disorders, 21(1), 174. https://doi.org/10.1186/s12891-020-3067-1
- Hakim, A. J., & Grahame, R. (2003). A simple questionnaire to detect hypermobility: An adjunct to the assessment of patients with diffuse musculoskeletal pain. International Journal of Clinical Practice, 57(3), 163–166. https://doi.org/10.1111/j.1742-1241.2003.tb10455.x
- Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. https://doi.org/10.1017/S0033291704002892
- Li, L., Yao, H., Zhang, L., Garcia-Argibay, M., Du Rietz, E., Brikell, I., Solmi, M., Cortese, S., Ramos-Quiroga, J. A., Ribasés, M., Chang, Z., & Larsson, H. (2023). Attention-deficit/hyperactivity disorder is associated with increased risk of cardiovascular diseases: A systematic review and meta-analysis. JCPP Advances, 3(3), e12158. https://doi.org/10.1002/jcv2.12158
- Reimherr, F. W., Marchant, B. K., Gift, T. E., Steans, T. A., Wilson, M., & Pommerville, C. (2022). Handbook of Utah scales for the assessment and treatment of ADHD in adults. https://perma.cc/F4VS-TMU5
- Sheeran, P., Listrom, O., & Gollwitzer, P. M. (2025). The when and how of planning: Meta-analysis of the scope and components of implementation intentions in 642 tests. European Review of Social Psychology, 36(1), 162–194. https://doi.org/10.1080/10463283.2024.2334563
- Ward, M. F., Wender, P. H., & Reimherr, F. W. (1993). The Wender Utah Rating Scale: An aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. American Journal of Psychiatry, 150(6), 885–890. https://doi.org/10.1176/ajp.150.6.885
- Yang, Y., Wu, C.-H., Sun, L., Zhang, T.-R., & Luo, J. (2025). The impact of physical activity on inhibitory control of adult ADHD: A systematic review and meta-analysis. Journal of Global Health, 15, 04025. https://doi.org/10.7189/jogh.15.04025
Your ADHD assessment
This is a resource rather than a file note. The first part is what we found and what each finding points to. The second is how those findings turn into something you can do. The third is what happens next. The fourth is for a clinician, and you never have to read it.
Your results, and what each one points to
Every finding below is followed by what it means for you in practice, and each suggestion sits with the result it came from.
ADHD, predominantly inattentive presentation
There are two symptom groups in the diagnosis. One is about attention and organisation, and you met seven of the nine. The other is about restlessness and acting without thinking, and you met three of the nine, which is below the threshold. That is why the diagnosis carries the word inattentive.
You asked whether you had wasted eight years being treated for anxiety. No. The anxiety was real and treating it was reasonable given what anyone knew. What this adds is a second condition underneath it that nobody had looked for. ADHD and anxiety occur together often, and the ADHD had not been part of the picture.
The group you do not meet is the group adults notice. A child out of her seat gets referred. A child described as away with the fairies gets a comment on a report card. Inattentive presentation is the one most often missed in girls, which is why a first diagnosis at thirty-four is common rather than unusual.
So: when you explain this to anyone, lead with the organisation and the time, not with attention. People hear "ADHD" and picture the other presentation, and you will spend the conversation correcting them.
The five things that had to be true
A diagnosis is not one finding. It is five separate questions, each answered from a different source.
The second line is documented here because you kept the reports. That is not usually possible in an adult assessment.
So: keep those three reports somewhere you can find them again, in case they are ever needed.
What was already happening, and who saw it
ADHD is present from childhood, so the pattern has to be there before the age of twelve. Yours is written down.
Early primary
Quiet, compliant, described as dreamy. Moved to the front of the class in two consecutive years, which your mother volunteered and you had not mentioned.
Your mother, informant questionnaire, completed aloneMiddle primary
"A lovely, quiet girl who could achieve so much more if she applied herself." Work "often left unfinished" and a tendency to be "away with the fairies during instructions".
School reports, Years 3 and 5Secondary
Grades held up through effort and long hours. You revised by rewriting everything, which took about three times as long as your friends.
Your recollection, interviewFamily history
Your father was described in similar terms and was never assessed. A niece has since been diagnosed.
Developmental and life history formThree of those four come from documents or from someone other than you, rather than from memory, so the childhood picture here is recorded rather than recalled.
So: the rewriting-everything strategy you invented at fifteen is the same strategy you are still running at thirty-four. It was never a study technique. It was a memory system that has supported your working memory since.
Where it shows up day to day
At work
Reports and assessments finished at home in the evenings because they cannot be done in the day. Two occasions this year where a deadline was missed and someone else noticed. You called the coordinator role "the first job where being good with the kids is not enough".
Preparation
Lesson planning that takes two to three times longer than colleagues describe, absorbed for years by starting earlier rather than by asking why.
Money and admin
A registration lapse, a period of unopened mail, and two years of not claiming on private health because the forms sat in a drawer.
At home
Household administration has migrated to your partner. You raised this before we did, and described the guilt as heavier than the tasks.
What it takes to hold
About an hour most evenings on lists, checking and rehearsing the next day.
What changed
Every one of these was held together by the timetable until 2024. None got harder. The thing holding them was removed.
Nothing about you got worse. The classroom job supplied structure that did part of the work for you: a timetable, a bell, thirty children who notice within seconds if you drift. The coordinator role removed most of that at once, and the demand transferred back onto your own systems.
So: the change needed is not more effort in the new role. It is to rebuild the structure the old role supplied, this time on purpose. Section two is how.
Five areas of day to day self-management, and what each one suggests
These five come from a questionnaire that compares your answers with other adults your age. The scores themselves are in section four. What matters here is what each one is doing to your week, and what could take that load off you.
Judging time and getting started early enough
Clearly significantJudging how long something will take is a common difficulty in ADHD, and it is likely the reason lesson planning takes two to three times longer than colleagues describe. The estimate made at the start does not match the time the task actually needs, so the shortfall gets made up in the evening.
Deadlines that live in a shared calendar with another person attached to them, rather than in your own estimate.
Why this follows: for twenty years a timetable did this for you and it was removed in 2024. A shared deadline is the same mechanism, supplied by the job instead of by you.
Holding several moving parts and putting them in order
Clearly significantHolding several competing tasks and working out the order to do them in is a common difficulty in ADHD, and the coordinator role asks for it constantly. The registration lapse and the unopened mail sit here too. The effort is in generating the order, not in doing the steps.
Standing templates for anything that recurs, so the sequence already exists instead of being rebuilt from nothing each time. Automatic payments for anything that can be automated.
Why this follows: a template is that order, written down once, on a day you had the capacity to write it. It is you doing the thinking in advance rather than in the moment.
Sustaining effort when nothing outside is supplying it
Clearly significantIn ADHD, sustained effort depends heavily on whether something outside is supplying a deadline or immediate feedback. Teaching supplies both constantly, which is why the classroom has never been the problem and the paperwork always has. The two deadlines you missed this year were both on work with no fixed external date attached.
A fortnightly slot with your line manager that forces sequencing to happen out loud, and puts a person at the other end of each piece of work.
Why this follows: the deadlines you have never missed are the ones with a room full of students at the other end. Someone expecting an answer at a set time is what makes this capacity available.
Settling after a strong reaction
Just below significantThis sits just under the range. Anxiety in the severe range affects the same answers, so the score is hard to read cleanly, and it may look different once sleep and load are addressed.
Nothing yet. Deal with sleep first and re-look at this in a few months.
Why this follows: acting on an unclear reading risks treating the wrong thing. This is one to watch rather than one to work on.
Acting before thinking
Typical rangeYours sits comfortably in the typical range. You have never been impulsive, so you never looked the part. This is the clearest single reason your diagnosis carries the inattentive specifier.
This is an area that does not need support, which tells you where not to spend effort.
Why this follows: ADHD presents differently from person to person, and a strategy, book or coach pitched at impulse control is aimed at a different presentation. It is unlikely to help here, which is worth knowing before spending time on it.
How much you are compensating, and whether it is working
One of the questionnaires asks two things the others cannot see. How much you rely on workarounds, and how well those workarounds are holding. Read together, they show how much effort the week is costing and how much of that effort is coming back.
Your use of strategies came out very high. Lists, alarms, rewriting things to remember them, asking your partner to remind you, arriving early to buy thinking time. You run more external structure than most people would guess from the outside. Their effectiveness came out low.
High use with low effectiveness is a common pattern in adults diagnosed late. It is what happens when the demand outgrows what personal effort can absorb, and it is usually what brings someone to an assessment. It is the clearest reason this question came up now rather than five years ago.
So: the answer is not another strategy. You already run more than most people. The change is in who carries the ones you already have, which is what section two sets out.
Four strengths, each tied to something in the assessment
01 · You built your own external memory system without being taught one
Evidence: your strategy use score, and the interview. Nobody taught you any of this. You worked out on your own that the load had to sit somewhere other than working memory, built lists, alarms and rewriting to hold it, and ran that for twenty years. It stopped working because the demand grew past what a system you maintain by hand can hold, not because the system was built badly.
You do not need to be taught how to build a system. You need the ones you build to stop depending on you to run them.
02 · You perform well in the conditions your scores predict would be hardest
Evidence: the self-motivation result read against your account of the classroom. That score normally predicts difficulty sustaining effort, and yet the classroom has never been the problem. Where feedback is immediate and thirty students respond in real time, the drive is supplied by the room rather than by you, so the part of the system that struggles is not being asked to do the work.
Know which conditions bring out your best rather than assuming the difficulty is everywhere. If you ever redesign your role, protect the contact time and negotiate the administration.
03 · You were using the job as an external scaffold for twenty years
Evidence: your work history, and the timing of the change in 2024. A timetable, a bell, fixed periods and thirty students who notice within seconds if you drift were carrying part of the load your own planning and time systems would otherwise have had to carry. You did not design that scaffold, but you found work that had it and stayed in that work for two decades.
The coordinator role removed most of it at once. The demand transferred back onto your own systems, they had to carry more than before, and your performance changed within months. Nothing about your capacity changed in that time. The load did.
Your difficulty moves with how much external structure is available, rather than sitting at a fixed level. That is worth knowing, because it means it is addressable by changing the structure rather than by changing you.
So: when you weigh up a role, count the structure in it as part of what it pays. A job with a fixed timetable is not just a job with a fixed timetable.
04 · Your account of yourself matched the independent record
Evidence: your self-report checked against three school reports and your mother's separate questionnaire. What you told us about being eight matched what three different teachers wrote in 2000 and 2002, and matched what your mother described without you in the room. Your childhood questionnaire score pointed the same way once the fuller scoring was applied.
Most of an adult ADHD assessment relies on self-report, with nothing external to check it against. Here there were three independent sources, and all three agreed with your account.
When you report that something is or is not working, that report can be acted on directly rather than treated as a starting point for further checking.
So: this matters most in a medication conversation. A prescriber adjusting a dose has almost nothing to go on except your account of the effect, and yours has already been tested against outside evidence.
How those findings turn into something you can do
Section one put a suggestion beside each result. This section sets out why those suggestions take the form they do, and how to run them as systems rather than as intentions.
We look at systems before we look at effort
Working memory, time blindness and the gap between deciding and doing are the parts of ADHD that respond least to effort, and effort is what has been carrying them for twenty years. They respond to being handled outside your head, by something that runs whether or not you remember to run it. When a system holds the demand, your brain is not being asked to do the thing it is least inclined to do, and the capacity that was going into holding it is free for something else.
The lists, the rewriting, the checking before you leave the house: that already has a name. It is called cognitive offloading, and it means putting a demand somewhere outside your head so the remembering is done by the world instead of by you. You have been doing it since primary school without anyone naming it.
It works. A 2026 meta-analysis found that using an external aid improves performance on memory-based tasks, and separately that it narrows the spread between people, more so for remembering to do something later than for recalling something past (Burnett & Richmond, 2026). That is the part your results put in the clinically significant range.
What has changed is not you. It is where the system lives. Yours is private, held in your head and on paper you maintain, which is exactly why your strategy use is very high and its effectiveness is low. A school timetable is the same idea, supplied by the building. The Australian ADHD guideline calls that environmental modification, and lists it among the components that belong in cognitive behavioural work with adults (AADPA, 2022, clinical practice point 4.2.13).
Four moves that turn a suggestion into a system
Every recommendation in section one is one of these four, pointed at a particular result.
Put it down the moment it arrives
The thought on the drive home, the thing a parent mentions at pickup, the resource you will need on Thursday. Working memory holds only a few items at once, and anything still sitting there is using capacity you need for something else. One place, always the same place, and a voice note counts.
Attach it to a moment, not to a day
"When the last student leaves, I write tomorrow's three things" beats "I will plan better this term". Plans tied to a trigger outperform plans tied to a time, across 642 tests. The average advantage was small to begin with, and under one method of correcting for publication bias it falls further, so treat it as a small real gain rather than a fix. It also only shows up when you actually want the thing done (Sheeran, Listrom, & Gollwitzer, 2025).
Let the job hold the structure instead of you
This is the one that matters most for you, and it is where four of the five suggestions in section one land. A shared calendar with real deadlines, a standing agenda template, a fortnightly slot with your line manager. Structure the workplace supplies costs you nothing to run. Structure you supply comes out of your own capacity every day, which is what the last two years have been.
Build one, and live with it for a month
You already run more strategies than most people, so more is not the answer. Set one up, use it for a month, and add the next only once the first has stopped needing your attention.
If you only do two things
Deal with the sleep first
Six hours on a work night with an hour to fall asleep is making every area above worse, and while it continues it is hard to tell what is ADHD and what is exhaustion. Of everything in this report it is the quickest to shift, and it makes the rest easier to read.
Take it to your GP as insomnia, on its own, not as part of the ADHD conversation. Raised the other way it tends to get treated as a symptom of something else. The guideline asks clinicians to ask about sleep and to offer strategies or a referral where one is needed, as part of adult ADHD care rather than around the edges of it (AADPA, 2022, clinical practice point 4.1.1).
Move one piece of structure out of your head and into the job
Not all of it. One. The fortnightly slot with your line manager is the strongest candidate, because it does work for two of the three significant areas at once: it puts a person at the other end of unstructured work, and it forces sequencing to happen out loud.
It costs you one conversation to set up and then runs on someone else's calendar. That is the test for anything worth building: once it exists, does it need you.
Two things we are not going to do
An app that claims to treat ADHD is a different thing from a reminder that fires at the right moment. A 2025 review of 26 systematic reviews found the evidence for digital interventions aimed at improving ADHD symptoms weak and inconsistent, with psychoeducation the clearest exception, and found adverse effects poorly reported (Gabarron, Denecke, & Lopez-Campos, 2025). Nothing above is a treatment. These are tools that hold a demand for you.
You have eight years of anxiety treatment behind you and a new explanation in front of you, and it is tempting to decide the anxiety was always secondary and can now be dropped. We would not assume that. Keep the two questions apart, give the changes a few months, then look at the anxiety again on its own terms with your GP.
Every study named above describes what happened, on average, to a group of people who are not you. That is a reasonable basis for choosing where to start and a poor basis for predicting how it will go. If something here does not fit, that is information about the tool rather than about you.
What happens now, and what it costs
Four things are available and none of them is expected. Doing nothing for a while is a legitimate choice and a common one.
Your options
| What you could do | What it involves | Cost |
|---|---|---|
| Sit with it | Read the report again in a month. A lot of people need the answer to settle before they do anything with it. | Nothing |
| Start with sleep | Take it to your GP as insomnia in its own right. The change with the shortest distance between effort and effect. | Standard GP fee |
| Use what is already in here | The five suggestions in section one and the two in section two. All of it is written down so you can work through it alone. | Nothing |
| Work with a psychologist | How to run a week differently, and what eight years of a different explanation has left behind. | $240, or $260 after 5pm and Saturdays. With a Mental Health Treatment Plan the rebate is $101.55, so $138.45 out of pocket, or $158.45 after hours. |
| Explore medication | Your GP extends a referral to a psychiatrist, who does their own assessment. The clinical report from this assessment goes with them. | See below. Your GP also arranges the tests listed further down. |
If you go down the medication path, there are two routes
The fees below are Dr Luisa Fernandez's, and they apply only if you choose to work with her. She is the psychiatrist we refer to, not the only one you can see, and another psychiatrist will have their own fees. The two routes differ in who holds the prescribing once the dose is settled.
Your GP prescribes
She assesses you once, writes a plan, and hands care back to your GP, who prescribes from then on. There is no routine review with her afterwards.
This only works if your GP is willing to take the prescribing on, so we ask them to confirm that before anything is booked.
The psychiatrist prescribes
She takes you on as her patient and manages the medication and the dose herself, with a review at about a month and then roughly every six months.
Your GP is not asked to prescribe, which makes this the route when they would rather not.
These are Dr Fernandez's fees, set by her rooms and not by Equal Psychology, and correct at September 2026. Benefits shown are the 85 per cent benefit for these items as they stand from 1 July 2026 and are indexed each year. Either route is a separate appointment with a separate fee, booked directly with her practice. Equal Psychology receives no payment or benefit for referring.
Worth raising with your GP
Two answers on your physical screen were positive and the rest were negative. Everything below is a conversation to open rather than a problem we have identified. A screening question is not a diagnosis, and we are not able to advise on physical health.
| What to raise | Why it is on the list |
|---|---|
| Your sleep, as its own problem | An hour to fall asleep and six hours on a work night is worth attention regardless of anything else in this report. |
| Iron | Your history form records that iron has never been tested. Your thyroid was checked in 2024 and was normal. The Australian guideline suggests both are worth establishing. |
| Lightheadedness on standing | You reported this most days, settling when you sit. We asked four questions about it. They are not a test and they name no condition. |
| Your joints | You answered yes to three of five questions about joint flexibility. A prompt for a conversation about whether a musculoskeletal review is worthwhile, nothing more. |
| The anxiety medication | Any decision about that is your GP's and yours. We would suggest not changing anything on the strength of this report alone. |
| Tests before a psychiatry appointment | Full blood examination, thyroid function, liver function, iron studies, vitamin B12, HbA1c, a lipid profile, an ECG, and a baseline blood pressure and heart rate. Your GP arranges these, and the iron question above is covered by them. |
Other places to get support
Adjustments at work
Because the job stopped supplying the structure, and that is the fixable part. Adjustments in a school are ordinary rather than exceptional, and they are the practical form of what the guideline calls environmental modification. Most can be asked for without naming a diagnosis. We can write a letter describing what you need without naming it, if you want one.
Other adults who have it
Because you recognised yourself in two students' reports before anyone asked you to. ADHD Australia keeps a directory of support groups at adhdaustralia.org.au. ADHD Foundation Australia runs online groups at adhdfoundation.org.au. Neither assesses or treats anyone. What they have is the practical version of all this, including what it is like to be diagnosed at thirty-four rather than at eight. Free, and nobody needs a referral.
The autism question, if you ever want it settled
Because your screen came back at 17 and we left it open. We have not answered this and we are not going to pretend otherwise. Settling it means a separate assessment rather than an addition to this one. It is available whenever you want it, and leaving it open is a reasonable choice rather than an unfinished task.
What this assessment does not settle
Whether the anxiety is now a condition in its own right or a consequence of years of working twice as hard without knowing why. Your own account is that it is worst before the parts of the job that need organisation, which is a plausible sequence rather than a finding.
Whether autistic traits are part of your picture. The screen came back at 17, and a screening questionnaire cannot settle that either way.
Anything about your physical health. We asked. We did not test.
Who reads this is your decision
This report belongs to you. We do not send it anywhere without your say-so. Most people give it to their GP. A psychiatrist does not need it, because they get the clinical version written for them. Beyond that it is entirely up to you.
One thing to think about before you hand it further. Employers, insurers and licensing bodies sometimes ask health questions, and what you are obliged to tell them varies by the policy and the situation. We are not able to advise you on that and would be out of our depth if we tried. If you are ever asked, get your own advice first, and talk to us before you send anything. We can prepare a version with any section left out, and we can write something shorter for a specific purpose.
If any part of this report is wrong, or lands differently than it did in the room, tell us and we will change it. It is your record.
You did the job well for twenty years while carrying a load nobody had identified. That is a starting point, not a deficit to fix.
For a clinician
The method, the scores with their reference points, the evidence table and the alternatives worked through. This part is written for a GP or another psychologist reading over your shoulder. It is here because it is yours, not because you need to read it.
The scores behind section one
Five areas of day to day self-management, compared with other women the same age. The bar runs from the 0th percentile on the left to the 100th on the right. The 85th and 93rd percentiles mark the band boundaries, and the 93rd is the threshold for clinically significant.
Judging how long something will take and getting it started early enough.
Holding several moving parts at once and sequencing them.
Sustaining drive on something with no immediate payoff and no one waiting.
Sitting just below the significant range, and difficult to read cleanly while anxiety is in the severe range.
Acting before thinking. The clearest single reason the diagnosis carries the inattentive specifier.
Compensatory strategies
These two scales have no comparison group. The positions describe the answers. They are not percentiles, and they should be read together rather than separately.
High use with low effectiveness describes compensation that is no longer absorbing the demand. Note that in the validation study the present-oriented effectiveness scale was related to symptoms, executive dysfunction and impairment while the future-oriented scale was not, and the direction of that relationship is not settled, so neither scale should be read on its own as an index of how well someone is managing (Castagna, Roye, & Calamia, 2019).
Every source, and what each one showed
| Source | What it showed | What that speaks to |
|---|---|---|
| ASRS v1.1 | Four of six screening items at or above threshold. All four were inattentive items. The hyperactive items were not endorsed. | The pattern now, and its shape |
| School reports | Years 3 and 5, written by two different teachers, both describing work not finished and attention drifting. | Childhood onset, in writing |
| WURS-45 | Raw score 44 against a cut-off of 46. Fuller scoring plus 2.4 against depression and anxiety and plus 3.1 against a non-clinical comparison, both on the ADHD side. | Childhood onset, and which kind |
| Informant questionnaire | Her mother, answering separately and without the client present, described the same pattern and added detail the client had not. | A second account, given independently |
| Clinical interview | Seven of nine inattentive criteria met, three of nine hyperactive-impulsive, across work and home, with impact described in specifics. | Current criteria, settings and impact |
What was used, and what each part cannot tell us
| Instrument | Completed by | What it can tell us | What it cannot |
|---|---|---|---|
| ASRS v1.1 | Client | How often the core patterns show up now (Kessler et al., 2005) | Nothing about childhood, and it misses roughly three adults in ten who do have ADHD. |
| WURS-45 | Client | How much of the pattern was there in childhood, and whether that childhood looks more like ADHD or more like anxiety (Ward et al., 1993; Reimherr et al., 2022) | It relies on memory of decades ago. |
| BDEFS | Client | Five areas of day to day self-management, compared with other women the same age (Barkley, 2011) | Why those areas are difficult. |
| CABS | Client | How much she relies on workarounds, and whether they hold (Castagna et al., 2019) | It has no scores to compare against. |
| School reports | Three teachers, 2000 and 2002 | What three adults with no stake in the question wrote at the time | They were not written with any of this in mind. |
| Informant questionnaire | Her mother, separately | How childhood looked from outside, in her words | It is her recollection too. |
| Clinical interview | Matthew, across two sessions | The alternatives, the impact, and whether each criterion is actually met | It works from what is disclosed and what is remembered. |
What else was considered
The alternatives were worked through before the diagnosis was made. Four of them remain live rather than excluded.
Anxiety · present, and needs its own attention
Screening returned anxiety in the severe range and stress in the severe range. This is the alternative that had to be taken seriously, because anxiety produces difficulty concentrating in anyone, and she has been treated for it for eight years.
Three things point to it arriving second rather than first. The attentional pattern is documented in school reports two decades before the anxiety began. It has been present across stretches of life she describes as settled as well as difficult. And the childhood measure, built to tell an ADHD childhood from an anxious one, came out on the ADHD side.
What has not been done is deciding whether the anxiety is now a separate condition in its own right or a consequence of years of working twice as hard without knowing why. Her own account is that it is worst before the parts of the job that need organisation, which is a plausible sequence rather than a finding. It is left open deliberately.
Depression · flagged as context
Depression score in the moderate range. Treated as something that colours the day to day picture rather than as the main explanation, because the attentional pattern is lifelong and present independent of mood. Worth watching, and worth reviewing again once sleep and workload have been addressed.
Autistic traits · flagged, and unresolved
RAADS-14 Screen score of 17, where 14 is the point at which we look further. That screen is deliberately over-inclusive, and the published median for adults with ADHD is 15, already above the cut-off, so 17 in someone with ADHD is a soft signal rather than a strong one. Some of what it picks up, particularly around social situations, overlaps with anxiety, which is in the severe range here.
Not a yes and not a no. A screening questionnaire cannot settle it, and neither could two sessions focused on a different question. A fuller set of autism questionnaires can be issued, and if the picture supports it, a proper autism assessment is the next step rather than an inference from this number.
Trauma and early life · considered
The trauma screen begins by asking whether anything of that kind has happened and only continues if the answer is yes. Hers continued and scored below the level at which we would explore further, and nothing in the interview suggested this was driving the pattern.
Sleep · flagged to follow up
Screen positive for insomnia. Into bed at ten, not asleep until close to midnight, waking at six, running on about six hours through the week. Short sleep amplifies attention and emotional regulation difficulties in anyone, and is likely doing so here. It does not account for the school reports. It is worth addressing in its own right and it sits in the GP conversation.
Alcohol and other substances · considered, not a factor
Asked as part of the history rather than through a scored questionnaire, because substance use can shape the picture. Nothing described is a complicating factor here.
Physical contributors · flagged for the GP
Thyroid problems, low iron and other physical causes can produce fatigue and poor concentration that look like ADHD, and the Australian guideline treats screening for them as part of a thorough assessment (AADPA, 2022). Thyroid checked in 2024 and normal. Iron never tested, which is worth a conversation. Two other answers came back positive and are set out in the GP section.
"Am I just bad at my job?" · considered, does not account for it
This does not hold, because of timing and consistency. The pattern is in her Year 3 report, written when her job was being eight. It has been present through periods when she was, by her own account and her appraisals, doing the work well. What changed recently was the amount of unstructured administration, not her competence.
The effort of holding it together. High strategy use with low effectiveness is the signature of compensation that has run out of room, and it is usually the source of the tiredness.
Sleep. Six hours on a work night amplifies attention and emotional regulation difficulties in anyone.
Anxiety load. Severe-range anxiety turns the volume up on everything above. Not a separate explanation, and not nothing either.
Limits of this assessment
Four of the seven sources are self-report, which record how she experiences her own functioning rather than an objective measure of it. The childhood picture is the exception and is unusually well documented. No cognitive or academic testing was done, so this says nothing about learning difficulties or ability. Physical contributors were screened by questionnaire rather than tested. The autism question is unresolved and the anxiety sequence is unresolved, and both are named as such rather than settled in prose.
References
- Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A systematic review of ADHD in adult women. Journal of Attention Disorders, 27(7), 645–657. https://doi.org/10.1177/10870547231161533
- Australasian ADHD Professionals Association. (2022). Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). https://adhdguideline.aadpa.com.au
- Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65–94. https://doi.org/10.1037/0033-2909.121.1.65
- Barkley, R. A. (2011). Barkley Deficits in Executive Functioning Scale (BDEFS for adults). Guilford Press.
- Burnett, L. K., & Richmond, L. L. (2026). Meta-analytic investigations of the effect of cognitive offloading on memory-based task performance and interindividual variability. Memory & Cognition, 54(1), 144–168. https://doi.org/10.3758/s13421-025-01743-8
- Castagna, P. J., Roye, S., & Calamia, M. (2019). The Compensatory ADHD Behaviors Scale (CABS): Development and initial validation. Assessment, 26(5), 783–798. https://doi.org/10.1177/1073191118774841
- Gabarron, E., Denecke, K., & Lopez-Campos, G. (2025). Evaluating the evidence: A systematic review of reviews of the effectiveness and safety of digital interventions for ADHD. BMC Psychiatry, 25(1), 414. https://doi.org/10.1186/s12888-025-06825-0
- Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. https://doi.org/10.1017/S0033291704002892
- Reimherr, F. W., Marchant, B. K., Gift, T. E., Steans, T. A., Wilson, M., & Pommerville, C. (2022). Handbook of Utah scales for the assessment and treatment of ADHD in adults. https://perma.cc/F4VS-TMU5
- Sheeran, P., Listrom, O., & Gollwitzer, P. M. (2025). The when and how of planning: Meta-analysis of the scope and components of implementation intentions in 642 tests. European Review of Social Psychology, 36(1), 162–194. https://doi.org/10.1080/10463283.2024.2334563
- Ward, M. F., Wender, P. H., & Reimherr, F. W. (1993). The Wender Utah Rating Scale: An aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. American Journal of Psychiatry, 150(6), 885–890. https://doi.org/10.1176/ajp.150.6.885
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